During the processing of a healthcare transaction by a healthcare provider, such as a pharmacy or hospital, a healthcare claim, such as an insurance claim, is typically made by the healthcare provider in order to receive compensation for provided products and/or services. However, in many situations, a patient may have dual prescription coverage and/or multiple benefit payers. For example, a commercial insurance provider may cover all the cost of a medication except for a patient responsibility amount. A state provider, such as a Medicaid provider, may then cover the patient responsibility amount. In dual or multiple coverage situations, a healthcare provider must submit claims to each benefit provider separately and inform providers of amounts that have been paid by previous providers. Such individual claim submissions may be time consuming for the healthcare provider and may be susceptible to inaccuracies as employees of the healthcare provider submit multiple claim requests.
Therefore, a need exists for systems and methods for the intelligent coordination of benefits in healthcare transactions.